Hugo Chavez has won his third presidential election in Venezuela, thanks to his customary generous spending on the poor in advance of the vote. Even though he won by a 10 percent margin, it is less than the anti-U.S. strongman is accustomed to receiving. He won by 27 percentage points six years ago.

Perhaps the only people happier than Chavez’s inner circle were those in the Cuban leadership, whose country depends on heavily subsidized sales of oil from Venezuela, which sits atop huge reserves.

But inefficient and top-heavy management and a lack of outside investment are threatening the reliability of production in Venezuela’s single-resource economy. Since his last election, Chavez has had to deal with a soaring crime rate, a deteriorating electric grid, double-digit inflation, chronic shortages due to government meddling, and expropriation of successful businesses and ranches.

Still, Venezuela’s large and swelling population of the poor are grateful for the housing, education, medical care and food subsidies that he provides, even though the country is less and less able to afford them.

Chavez has tried to carve out a role for himself on the international stage by trying to organize other leftist Latin America nations — Cuba, Nicaragua, Bolivia, Ecuador and Argentina — into an anti-U.S. alliance, by playing footsie with Iran, and by pulling such stunts as a joint naval exercise with Russia.

He regularly predicts an imminent American invasion, to the increasing disbelief of the Venezuela people.

The only restraint on his grip on power, and his ability to cause mischief for the U.S., is his questionable health. He has had at least two and, according to some sources, as many as three pelvic surgeries — presumably for cancer — along with radiation and chemotherapy treatment in the past 16 months.

He has pronounced himself cancer-free and in complete recovery, but in truth, he does not look like a healthy man. If he dies in the first four years of his six-year term there will be a new election and a good bet to win it is his opponent in the most recent vote, former state governor Henrique Capriles, who received a respectable 6.1 million votes in his losing endeavor. Chavez secured 7.4 million votes this time.

Unless health problems intervene, Chavez plans to proceed with his “Bolivarian revolution,” modeled heavily on the Cuban model in which the state controls all the meaningful components of the economy.

This is no more a happy prospect for the people of Venezuela than it was for the people of Cuba.